World Rural Health Conference
Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 611
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 4  |  Page : 381-383  

The vulnerable Indian one rupee coin


1 Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
2 Department of Preventive Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India

Date of Web Publication31-Dec-2013

Correspondence Address:
Arvind Krishnamurthy
Department of Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Adyar, Chennai - 600 020, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4863.123927

Rights and Permissions
  Abstract 

Coins are the most commonly ingested foreign body encountered in the pediatric population, with a peak incidence between 6 months and 3 years of age. Although some ingested coins may be aspirated, most coins pass through the alimentary tract without causing any complications. Coins in the esophagus causing symptoms require immediate removal. The management of asymptomatic coins has been a perplexing problem to the clinicians for decades. We recently managed an interesting case of an impacted Indian one rupee coin in the esophagus of a 13-year-old girl, by performing a simple yet novel technique, by using a conventional flexible endoscopic biopsy forceps. Further, reviewing the literature we inferred that the rounded, stainless steel Indian one rupee coin with a diameter of 25 mm, by itself seems to be vulnerable for impaction in the esophagus and therefore needs to be promptly addressed even if asymptomatic.

Keywords: Coin, esophageal foreign body, flexible esophagoscopy


How to cite this article:
Krishnamurthy A, Ramshankar V. The vulnerable Indian one rupee coin. J Family Med Prim Care 2013;2:381-3

How to cite this URL:
Krishnamurthy A, Ramshankar V. The vulnerable Indian one rupee coin. J Family Med Prim Care [serial online] 2013 [cited 2019 Aug 19];2:381-3. Available from: http://www.jfmpc.com/text.asp?2013/2/4/381/123927


  Introduction Top


Coins are the most commonly ingested foreign body encountered in the pediatric population, with a peak incidence between 6 months and 3 years of age. [1],[2] While some ingested coins may be aspirated, most coins pass through the alimentary tract without causing any complications. However, some coins can become impacted and have the potential to cause serious complications such as mediastinitis, empeyma, perforation or even cause an aortoesophageal fistula. Coins in the esophagus causing symptoms require immediate removal. The management of asymptomatic coins has been a perplexing problem to the clinician for decades, [2] we describe our experience of managing an impacted Indian one rupee coin.


  Case Report Top


A 13-year-old girl was brought to our emergency department by her caregiver, 1 h after ingestion of an Indian one rupee coin. She was asymptomatic at presentation and her clinical examination was unremarkable. A frontal and lateral chest skiagram showed a rounded coin shadow in the upper esophagus, at the level of the aortic arch [Figure 1]. She was taken up for removal of the coin under propofol sedation after a 12 h period of watchful waiting. A flexible esophagoscope was introduced per-orally and the impacted Indian one rupee coin was visualized in the esophagus at a distance of 24 cm from the incisors. A non-serrated 2.8 mm disposable endoscopic biopsy forceps without a needle was introduced through the working channel of the flexible esophagoscope and the Indian one rupee coin was firmly grasped in between the jaws of the biopsy forceps. The flexible esophagoscope was withdrawn along with the biopsy forceps and the coin was safely removed [Figure 2] and [Figure 3]. Patient was counseled and discharged the same day evening.
Figure 1: A frontal and lateral chest skiagram showed a rounded coin shadow in the proximal esophagus at the level of the aortic arch

Click here to view
Figure 2: Flexible esophagoscopy showing the biopsy forceps just prior to grasping the Indian one rupee coin lodged in the esophagus, 22 cm from the incisors

Click here to view
Figure 3: The extracted Indian one rupee coin

Click here to view



  Discussion Top


Esophageal foreign body impaction is a serious medical emergency demanding timely recognition and prompt action. The lodgment site for esophageal foreign bodies is said to be influenced by age, foreign body size, type and the duration of ingestion. The common sites of lodging of the coins are at the cricopharynx (70%), at the level of the aortic arch (15%) and at the gastro esophageal junction (15%).

Classic teaching has stressed that ingested coins in the esophagus are aligned in the coronal plane on frontal chest radiographs, whereas aspirated coins in the trachea assume a sagittal orientation. However, a recent case series differs from the classic teaching in stating that a coin seen with a sagittal orientation on a chest radiograph is more likely to be within the esophagus rather than within the trachea. [3]

It has been reported that coins lodged in the proximal esophagus and those retained for more than 16-24 h are less likely to pass and needs intervention. [4] In a study pertaining to the impact of the diameter of the coin and its retention, it was reported that most retained coins had a diameter between 23.45 and 26 mm. [5] The rounded, stainless steel Indian one rupee coin with a diameter of 25 mm, seems to be vulnerable for impaction. [6]

A variety of management options are available that include endoscopic removal (rigid/flexible) Foley catheter removal, esophageal bougienage, Magill forceps extraction and a wait and watch policy. The best modality of removal of foreign body has been a subject of controversy. The choice of treatment is influenced by many factors, which include, the age of patient, size and shape of the foreign body, anatomical location and the expertise of the treating clinician. Among them the most popular technique of removal of impacted esophageal coins in is by rigid esophagoscopy. This method required general anesthesia with muscle relaxation and is known to be associated with 2-10% risk of perforation during foreign body removal.

Flexible esophagoscopy is a safe and reliable method for removal of impacted foreign bodies throughout the esophagus and can be performed under propofol sedation. [7] Propofol is a commonly used intravenous anesthetic agent for endoscopic procedures. A variety of instruments such as grasping forceps, retrieval baskets or loops may be used to retrieve foreign bodies, dependent upon the type of object involved. Selection of the appropriate instrument will minimize any risk of the foreign object being released prematurely and causing further trauma. The jaws of a regular biopsy forceps without a needle can be used to firmly grasp and extract the coin as was successfully done in our case.


  Conclusion Top


Impacted coins in the esophagus need to be promptly diagnosed and addressed; a simple chest X-ray is more of less diagnostic of the same. In addition, coins with a diameter between 23.45 and 26 mm seem to be more vulnerable of impaction and therefore needs to be promptly addressed even if asymptomatic. Extraction of impacted coins with the aid of a regular endoscopic biopsy forceps seems to be a safe, effective and attractive option.

 
  References Top

1.McNeill MB, Sperry SL, Crockett SD, Miller CB, Shaheen NJ, Dellon ES. Epidemiology and management of oesophageal coin impaction in children. Dig Liver Dis 2012;44:482-6.  Back to cited text no. 1
[PUBMED]    
2.Waltzman ML. Management of esophageal coins. Curr Opin Pediatr 2006;18:571-4.  Back to cited text no. 2
[PUBMED]    
3.Conners GP, Chamberlain JM, Ochsenschlager DW. Symptoms and spontaneous passage of esophageal coins. Arch Pediatr Adolesc Med 1995;149:36-9.  Back to cited text no. 3
[PUBMED]    
4.Schlesinger AE, Crowe JE. Sagittal orientation of ingested coins in the esophagus in children. AJR Am J Roentgenol 2011;196:670-2.  Back to cited text no. 4
[PUBMED]    
5.Tander B, Yazici M, Rizalar R, Ariturk E, Ayyildiz SH, Bernay F. Coin ingestion in children: Which size is more risky? J Laparoendosc Adv Surg Tech A 2009;19:241-3.  Back to cited text no. 5
[PUBMED]    
6.Baral BK, Joshi RR, Bhattarai BK, Sewal RB. Removal of coin from upper esophageal tract in children with Magill′s forceps under propofol sedation. Nepal Med Coll J 2010;12:38-41.  Back to cited text no. 6
[PUBMED]    
7.Li ZS, Sun ZX, Zou DW, Xu GM, Wu RP, Liao Z. Endoscopic management of foreign bodies in the upper-GI tract: Experience with 1088 cases in China. Gastrointest Endosc 2006;64:485-92.  Back to cited text no. 7
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed1368    
    Printed52    
    Emailed2    
    PDF Downloaded178    
    Comments [Add]    

Recommend this journal